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EUROPEAN ACADEMIC RESEARCH
Vol. III, Issue 11/ February 2016
Impact Factor: 3.4546 (UIF)
DRJI Value: 5.9 (B+)
Epidemiology of Road Traffic Accidents in Sudan
ABEER HASSAN AHMED
College of Medicine, University of Hail
Kingdom of Saudi Arabia
ABDAL-HAFEEZ OSMAN MAHMOUD
Shendi University, Faculty of Medicine, Sudan
ABDALELAH MOHAMMED ALHASSAN
Faculty of Medicine, University of Gezira
HUSSAIN GADELKARIM AHMED1
Department of Histopathology and Cytology, FMLS
University of Khartoum, Sudan
Abstract:
Objective: the aim of this study was to assess the
epidemiological factors of Road Traffic Accident (RTA) in Sudan with
special emphases on human factors of victims. Methodology: Data
were collected using a questionnaire from victims and eyewitness and
traffic- police reports. Results: The incidence of traffic accident was in
progressive escalation with time. Younger individuals were twice
susceptible compared to elder. The highest number of RTA reported is
recorded in the rainy season. Conclusion: Morbidity and mortality
from RTA is prevalent in Sudan, particularly in Khartoum State.
Interventions include regulation, legislation and community projects
are needed to decrease the burden.
Key words: Sudan, Road Traffic Accident, Khartoum State
1 Corresponding author: [email protected]
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
Sudan
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INTRODUCTION
Death from road traffic injuries (RTI) and in particular Motor
vehicle Traffic Accidents (MVTA) have been characterized
worldwide as a hidden epidemic which affects all sectors of
society [1]. An estimated 1.26 million people worldwide died in
2000 from RTI, 90% of them in low and middle income
countries. According to the World Health Report 2002, of the
global burden of injury, 30.3% morbidity and 28.7% mortality
occurred in the South-East Asia Region [2]. In 2000, the RTI
mortality rate for the world was 20.8 per 1,00,000 population
(30.8 in males, 11.0 in females). The Asia-pacific region
accounts for about 60% of global road deaths despite having
only 16% of the world’s vehicles. In the Americas, it was 26.7
for males and 8.4 for females [3]. In the Americas during 1997-
2000 mortality from all land transport accidents was the tenth
leading cause of death in the general population [4].
Road traffic accidents are a public health issue and cost
a lot to individuals, families, communities and nations. The
estimated cost is around 1-2% of a country’s GNP in lower
income countries [2]. In the majority of cases, road accidents
are largely preventable and are usually caused by human
errors including alcohol drinking, over taking and speeding,
thus highlighting strict implementation of road safety
measures.
The severity of road traffic accident injuries is
influenced by a number of variables. Prominent among these
are population and vehicle densities which could be used to
assess fatality rate [5]. Since road users are not a uniform
population, drivers, motorcyclists, pedestrians and passengers
are exposed to different hazards and will therefore present
different epidemiological factors [6].
Developing countries bear a large share of the burden,
accounting for 85% of annual deaths and 90% of the disability-
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
Sudan
EUROPEAN ACADEMIC RESEARCH - Vol. III, Issue 11 / February 2016
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adjusted life years (Daly's) lost because of road traffic injury
[7,8]. And since road traffic injuries affect mainly males (73
percent of deaths) and those between 15 and 44 years old, this
burden is creating enormous economic hardship due to the loss
of family breadwinners.
According to a report of the General Directorate of Road
Traffic, Government of Sudan, road traffic accidents increase
every year, with the accident rate corresponding to 45 per
100 000 population. Khartoum State ranks first among other
states of Sudan in respect of accidents and the number growing
up from 4409 accidents in 1999 to 9347 accidents in 2008. Of
the total 71130 accidental injuries and 6885 accidental deaths,
95.3% injuries (324 520) and 33.2% deaths (81 036) were due to
road traffic. The sex ratio of road traffic injury in Khartoum
was 3.4 males: 1 female. Road traffic injuries affect mainly the
productive age group (74%) as reflected in the report [9].
Road traffic injuries are predictable and preventable,
but good data are important to understand the ways in which
road safety interventions and technology can be successfully
transferred from developed countries where they have proven
effective. Awareness of the consequences of road traffic injuries
is lagging among policymakers and the general public. What's
needed is incorporation of comprehensive road safety programs
into national planning. This is a cause of concern-underlining
the critical need for research and development on RTIs in
Khartoum State.
MATERIALS AND METHODS
This descriptive study was conducted in Sudan in the state of
Khartoum. The study group-consisted of all the RTA victims
reporting to Khartoum city casualty during the period from
2001 to 2010 with specific focus to the latest two years. For the
aim of the study, a RTA was distinct as accident, which
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
Sudan
EUROPEAN ACADEMIC RESEARCH - Vol. III, Issue 11 / February 2016
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happened on the road between two or more matters, one of
which must be any kind of a moving vehicle. Any injury on the
road without involvement of a vehicle (e.g. a person slipping
and falling on the road and sustaining injury) or injury
involving a stationary vehicle (e.g. persons getting injured
while washing or loading a vehicle) or deaths due to RTA were
excluded from the study. The victims of the accidents and
eyewitness were interviewed to obtain the information about
the circumstances leading to accident. A questionnaire
specifically designed for this purpose was used for interviewing
the accident victims, either in the casualty or in the wards of
Khartoum state different hospitals. More information were
obtained from traffic-police reports. The data collected involved
personal identification data, time, date, day and type of vehicles
involved in RTA, etc. Although the study retrieved data for 10
years, but the available survivors for the latest two years were
194 persons.
Data analysis: Data management was done by using the
Statistical Package for Social Sciences (SPSS version 16). SPSS
was used for analysis and to perform Fisher exact test for
statistical significance (p value). The 95% confidence level was
used. A p=0.05 was considered statistically significant.
Ethical consent: Consent was taken from accidents
survivors and eyewitness before interviewing them, in addition
to constitutional consent from Khartoum sate directorate of
traffic.
RESULTS
The present study investigated detailed variables on RTA for
194 persons, their ages ranging from 10-60 years, of whom 154
were males and 40 were females.
Table 1 Fig, 2and 3 summarize the incidence rates of
RTA during the period from 2001 to 2010. Casualties as well as,
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
Sudan
EUROPEAN ACADEMIC RESEARCH - Vol. III, Issue 11 / February 2016
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deaths rates were found to increase with time (each year is
greater than the previous), but mortality incidence rates
showed varying categories. The highest mortality incidence
rates were found in 2004 followed by 3003, 2002 and 2001
representing 2.9%, 2.8%, 2.7% and 2.6% respectively. The
number of traffic crashes registered has increased by three
times in 2010(46757) compared to 2001(15827). The incidence
rates were decreased from 2.6% (2001) to 1.9% (2010).
Table 1. Incidence rates of casualty in Khartoum State during the
period from 2001 to 2010. percent Mortality casualty year
2.6% 416 15827 2001
2.7% 462 17280 2002
2.8% 519 18581 2003
2.9% 651 21958 2004
2.3% 648 27712 2005
2.2% 748 34019 2006
2.1% 758 37402 2007
2.1% 810 39176 2008
1.9% 841 44668 2009
1.9% 891 46757 2010
Figure 1. Incidence rates of RTA’s casualty during the period from
2001 to 2010 in Khartoum State
Figure 2. Frequencies of RTA’s mortality during the period from 2001
to 2010 in Khartoum State
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
Sudan
EUROPEAN ACADEMIC RESEARCH - Vol. III, Issue 11 / February 2016
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Figure 3. Incidence rates of RTA’s mortality during the period from
2001 to 2010 in Khartoum State
In regard to the sex, males represent the greater number
154/194 (79.5%) compared to females 40/194 (20.5%). Moreover,
most of the study population were at the middle age as
indicated in Fig4. The age group 31-45 years represent the
greater number of the total RTA victims followed by 16-30
years. Considering age group 16-45 years, constitute 68.4% of
the total RTA victims.
Figure 4. Description of the study population by age
Regarding the injuries types, the highest percentage was
regarded as wounds followed by fractures and head injuries,
representing 59%, 33% and 8% respectively as shown in Fig5.
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
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Figure 5. Description of the study population by the type of the
injury
Regarding the severity of the injury, 46% of the injuries were
regarded as mild followed by medium and severe constituting
29% and 25% in this order, as shown in Fig 6.
Figure 6. Description of the study population by the severity of the
injury
As shown in Fig 7 most of the wheelers involved in the RTA
were 4-wheelers, followed by above 4-wheelers.
Figure 7. Description of the study population by the types of
wheelers
As shown in Fig 8 the majority of the victims were pedestrian
representing 48.5% followed by passengers 34% and
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
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drivers/riders 17.5%. Pedestrians are most vulnerable to injury
and death.
Figure 8. Description of the study population by Road users
The study found that incidence of RTA were maximum within 6
AM to 12 Noon (38.1%) followed by 1-6 PM 33.5% and 6 PM to
12 Midnight20.1%.
Figure 8. Description of the study population by time of an accident
It was observed that majority of accidents had been in the first
day after the week-end (Sunday) 17.3% followed by the last day
of work per week (Thursday) 15.3% and less frequency during
the week-end days. The maximum incidence of road traffic
accident was found to be during rainy season 39% especially in
August and September, as shown in Fig 9 and 10.
Figure 9. Description of the study population by the days
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
Sudan
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Figure 10. Description of the study population by the Season
Table 2. Shows the distribution of the study population by Place
of Accident occurrence. The study showed that frequency of
RTA was more (46.7%) in Khartoum locality and less in
Shargelneel locality (6%).
Table 2. Distribution of the study population by Place of
Accident occurrence Place Frequency Percent
Khartoum 90 46.7%
Omdurman 21 10.8%
Bahri 27 14%
Jabal awleia 17 9%
Shargelneel 12 6%
Karary 14 7%
Ombaduh 13 6.5%
The study showed that, the maximum frequency of nature of
occurrence is Pedestrian (46.8%) followed by collision (30.6%),
as indicated in Table 3.
Table 3. Distribution of the study population by Nature, type and
mode of occurrence of accidents
Nature Frequency Percent
Pedestrian 5028 46.8%
collision 3284 30.6%
overturning 864 8.1%
falling 749 6.9%
others 817 7.6%
This study found that, major contributing factor for crashes is
the errors of driver and over speeding (14.9%). Regarding
protective methods used, it is found that only (22.2%) among
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
Sudan
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the motorized two-wheeler drivers used protective helmets
during RTAs ,(13.7%) seat belts were found to have been used
by the car drivers and the occupants and (81.6%) of drivers had
a valid driving license.
Table 4. Distribution of the study population by Driver errors
Type of error frequency percent
turn 37 19.3%
deviation 28 14.5%
Beyond wrong 28 14.5%
Wrong rotation 23 12%
Override signal 16 7.8%
Back to back 15 7.7%
Over speeding 29 14.9%
others 18 9.3%
DISCUSSION
Investigating causes of traffic crashes is complicated by the fact
that a given crash seldom has a single unambiguous cause.
Crash causes are usually complex and involve many factors.
Based on studies conducted in different part of the world, it is
possible to construct a list of categories that could influence the
occurrence of road traffic crashes. If the factors that have
contributed to the crash are identified it is then possible to
modify and improve the transportation system.
This study found that, major contributing factor for
crashes is the errors of driver and over speeding (14.9%).
Although the relationship between speed and road traffic
crashes is a complex one, in general, the higher the speed of a
vehicle, the higher the probability of becoming involved in a
crash and the greater the likelihood of more severe injuries
sustained.
Over the last decade, the number of traffic crashes
registered has increased by three times in 2010(46757)
compared to 2001(15827). Age group 31-45 years shows almost
maximum number of total RTA victims followed by 16-30 years
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
Sudan
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age group. Similar findings were observed in other studies [9,
10]. A higher number of cases in this age group can probably be
explained on the basis that this is the most active period of life
during which there is a tendency to take risk. It was observed
that 68.4% of victims were in the age group of 16 to 45years.
This shows that people from the most active and productive age
groups are more involved in RTAs. This causes a serious
economic loss to the community. Similar observations were also
made in other studies [11,10]. It was noticed that below and
above the age of 16 and 46 years respectively, there is a
decrease in accident cases. The reason for this may be that
children are taken care of by elders and are less likely to use
vehicles. The lower proportion of RTAs in those aged 60 years
and above could be due to the generally less mobility of these
population groups.
The male/female ratio observed in this study was 4:1.
The predominance of males was also observed by many authors
[10]. This may be due to the fact that females lead a less active
life and mostly remain indoors.
The highest number (39%) of RTA victims who reported
was recorded in the rainy season. More accidents were observed
in rainy months like August and September followed by winter
season (31.2%). A similar observation was also reported by
others [9,11].
Analyzing the time of R T A, it is found that, incidents
were highest within 6 am -12 noon (38.1%) followed by 1-6 PM
(33.5%) and 6 PM to 12 Midnight (20.1%). A similar result was
observed by other studies [10,12] and differ in another one as
found in South India as accidents occurred throughout the day
but the peak time for RTAs showed that the highest number of
RTAs occurred form 4 PM to 7 PM [10]. There is sufficient
evidence in support of a high incidence of day-time accidents.
This can be explained by greater traffic volume during the day
resulting in greater risk of accident involvement as people
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
Sudan
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travel to work, children go to school, and commercial
enterprises are open for business. The relative decline in traffic
accidents at night may be explained by less night-time activity
and travel.
In the present study, the highest number of reported
accident occurred on Sundays (17.3%) and Thursdays (15.3%).
A similar observation was also reported by others [9, 10].
In Khartoum, Sundays and Thursdays are the first and
last working days of the week: this could be the possible reason
for the large number of accidents on these days. People
celebrate Friday as weekend and possibly are in a hurry to go to
various places to join their working places on the following
Sunday.
In this study the pedestrians constituted 48.5% of the
main road users involved in RTA, followed by passengers (34%).
Similar results were also observed by others [9,10, 12].
Pedestrians are most vulnerable to injury and death. This
reflects the ignorance of traffic rules and speed of the vehicle.
This may be due to a number of factors, including lack of
pedestrian facilities in road design, poor knowledge and
practice of road safety measures by the general population,
uncourteous behavior of motorists, high speed driving, and low
levels of vehicle ownership. The high proportions of passenger
incidence appear to be due to extensive use of public transport,
and the driving skill of their operators.
Considering the types of vehicle involved in RTA, 4-
wheeler is more than a half of the total victims followed by
above 4-wheeler vehicles and 3-wheeler vehicles. It reveals the
more use of 4 -wheeler vehicle by untrained persons. Similar
findings were reported by others [11,10]. Considering the place
of accident, it is found that is highest in Khartoum locality
(46.8%) which is more than one third of the total victims. It
reveals the overcrowding and the inadequate provision of wide
roads in this region.
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
Sudan
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The study showed that, the maximum frequency of nature of
road traffic accident occurrence is Pedestrian (46.8%) followed
by collision (30.6%). Different result was observed in Western
Nepal, Falling down was the more common mode of accident
claiming victims, followed by the knocked-down category [9].
Over 50% of the traffic accidents are due to excess speed and
violation of signals at intersections in Saudi Arabia [13]. From
the study it is also observed that, protective methods used
among the motorized two-wheeler drivers only (22.2%
protective helmets) during RTAs, (13.7%) seat belts were found
to have been used by the car drivers and the occupants and
(81.6%) of drivers had a valid driving license. Similar results
were also observed by others [10,12], but in Western Nepal all
drivers used the protective methods needed and had valid
driving license [9].
CONCLUSION:
Road traffic accidents continue to be a growing menace,
incurring heavy loss of valuable man-power and human
resources, along with a corresponding drain of potential
economic growth and hence.
Interventions in TRA are broad-based and include
regulation, legislation and community projects. However,
partnerships need to be formed with other sectors which
interact with Road Traffic Accidents. Public health sector can
play an important role in taking the lead in advocacy and
support; it can add value to epidemiology and information
systems, among others. The real pressure and motivation to
improve driving stricter, more comprehensive and scientifically
based test laying a stress on road rules, regulations and traffic
control devices.
Abeer Hassan Ahmed, Abdal-Hafeez Osman Mahmoud, Abdalelah Mohammed
Alhassan, Hussain Gadelkarim Ahmed- Epidemiology of Road Traffic Accidents in
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Acknowledgment
Authors would like to thank all those contributed to obtaining
the data including victim’s survivors, eyewitnesses and police
officers in Khartoum State.
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